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oral path > Viral infections > Flashcards

Viral infections Flashcards

1
Q

HSV-1 Herpes Labialis

A

Primary 6 months - 6 years old then latent in trigeminal ganglion

does best in mucosa and non intact skin (pharynx, eyes, lips)

yellow vesicles with red borders that burst into ulcers, crust on oropharynx, eyes, lips, genitals

secondary exposure will reactivate, often symptomatic

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2
Q

transmission of HSV1 herpes labialis

A

shed in saliva, close contact
wear glasses, mask
prevent prodromal symptoms with antivirals

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3
Q

HSV-1 Herpetic Whitlow

A

less common
occurs on fingers
red border, yellow vesicle

no dental work till resolved, self inoculation risk

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4
Q

Acute Herpetic Gingivostomatitis (primary herpes)

A

most common HSV infection, rapid onset

6 months-5 years old, sick
multiple vesicles rupture to ulcers on palate, lips, tongue, attached ging, vermillion border

gingival enlargement

avoid dental tx for 14 days

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5
Q

HSV-2 genital herpes

A

genital/oral
vesicles or ulcers

big increase in incidence
shed while asymptomatic

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6
Q

HSV 2 transmission

A

shed in saliva/genital secretions

risk of transmission to baby during birth (aseptic meningitis) but does not cross placenta

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7
Q

HSV-3 varicella zoster chicken pox

A

primary virus in dorsal spinal ganglion
VZV is primary symptomatic infection
total body rash, itchy
perioral and oral lesions

followed by latency, if it recurs= herpes zoster/shingles

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8
Q

HSV-3 transmission VZV

A

transmit thru air droplets and direct contact with lesions

risk if pregnant (defects, abortion), vaccinate MMR, avoid dental tx

tx: antiviral meds, non aspirin antipyretics to avoid Reyes Syndrome

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9
Q

HSV-3 Herpes Zoster complications

A

post herpetic neuralgia, Ramsey Hunt syndrome, blindness, tooth exfoliation, necrosis of mand

important to take antivirals within 72 hrs, treat oral lesions with topical, avoid contact with preg/unvaccinated

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10
Q

HSV-3 Shingles

A

recurrent unilateral vesicles, pustules, ulcers that crust

can affect 3 branches of trigeminal nerve, eyes, palate, ramus to midline on one side, trunk

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11
Q

HSV-4 EBV infectious mono

A

virus replicates in oropharynx
remains in host for life

oral hairy leukoplakia: white mucosal plaque on lateral tongue that does not rub off
commonly seen in AIDS, organ transplant, immunosuppressive aids

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12
Q

HSV-4 EBV transmission

A

shed in saliva, assoc with HIV

carcinomas: nasopharyngeal, Burkitt’s lymphoma, Hodgkin’s lymphoma, all CNS lymphomas in in AIDS, risk factor for non-Hodgkin’s

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13
Q

HSV5 Cytomegalovirus

A

persistent ulcers

50% of population infected by 40 years old
reactivated by preg, aids, blood transfusions

90% asymptomatic
symptomatic: chorioretinitis in AIDS <50

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14
Q

HSV-5 Cytomegalovirus transmission

A

shed in saliva, body fluids, crosses placenta affecting fetus (mental affects, deaf, heart defects)

assoc with AIDS <50 CD4

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15
Q

HSV-6 Roseola

A

3 months-3 years
sudden maculopapular rash, blanches
seizures with high fever

replicate in salivary glands

may also have otitis, GI, resp distress

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16
Q

HSV-7 Exanthem Subitum

A

fever with or without rash

usually older children

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17
Q

HSV-8 Kaposi’s sarcoma

A

painless purple red macules

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18
Q

HSV-9 Kaposi’s risks/tx

A

malignancy assoc wtih HIV/Aids

tx: chemo, excise, radiation, antiviral

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19
Q

Viruses

A

intracellular that infect cells to replicate
transient or long term infections, malignancy potential
reactivation with recurrent infections
all cause primary infection as child, remain latent
weakened defenses
shed in saliva or genital secretions

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20
Q

HSV-1 vs HSV-2

A

both are identical clinically, different locations
associated with non infectious processes (erythema multiforme)
affects epithelial cells

tx: primary= antivirals, restrict contact
recurrent= acyclovir in prodromal phase

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21
Q

Recurrent Herpes Simplex (secondary herpes)

A

most common at vermillion border
15-45% prevalence

prodromal: burning, itching, tingling
then multiple, red small red papules that form clusters of vesicles which rupture, crust heal with no scar

postpone dental

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22
Q

HSV-3 Herpes Zoster/Shingles

A

virus stored in dorsal ganglia or trigeminal ganglion
fever, malaise, pain, lymphadenopathy

3 phases
Prodrome: intense pain, inflammatory rxn
Acute: prodromal rash, vesicles, ulcers crust
Chronic: 15%, persistent pain

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23
Q

Cocksackie virus A16 (hand, foot, mouth)

A

symptomatic infections with rashes

intraoral: red sores on B mucosa, tongue, palate that turn into vesicles then blisters
extraoral: red macules then rash that blisters on palms, hands, soles, feet

2 types: herpangina and acute lymphononodular pharyngitis

24
Q

Cocksackie virus A16 transmission

A

fecal/oral and throat secretions

common in crowded areas with poor hygiene

postpone dental tx for all forms of virus due to contagious

25
Q

Herpangina

A

A16 common in children and summertime

diffuse gray and red vesicles rupture then ulcers on posterior mouth, soft palate, pharyngeal tonsils/pillars

lasts 3-4 days when fever breaks

26
Q

Acute Lymphononodular Pharyngitis

A

vesicles or small nodules in pharyngeal area and tonsillar pillars

rare, children mostly

caused by A10

27
Q

Paramyxovirus: Rubeola (hard measles)

A

prodromal: white koplik spots on oral mucosa then maculopapular rash on face

fever ends, rash fades

can cause pitted enamel, blind, death, pneumonia, encephalitis

28
Q

Paramyxovirus: hard measles rubeola tx

A

vaccine MMR

avoid dental tx contagious

29
Q

Togovirus: Rubella (german measles)

A

prodromal: Forscheimer’s sign in 20%
dark red papules on soft/hard palate

rash for 2 weeks on face, neck, trunk

crosses placenta barrier= birth defects (1st tri)

usually in spring

30
Q

Togovirus: german measles, rubella transmission

A

resp drop, nasopharyngeal secretions

reschedule if risk contact with preg person

31
Q

Mumps: paramyxovirus

A

diffuse disease of exocrine glands (salivary gland best site)

salivary gland swelling (20%) usually parotid and bilateral, may involve sublingual gland

Pain on chewing, ear swelling

complications: meningitis, deaf, arthritis etc.

32
Q

Mumps: paramyxovirus tx

A

vaccine MMR

postpone dental tx till safe

33
Q

Human Papilloma Virus

A

over 140 viruses

24 assoc with head and neck

1/3 of pop, shed in saliva

HIV+ more likely to have HPV

family: retroviridae
genus: lentivirus

34
Q

HPV oral squamous papilloma

A

caused by HPV 2,6,11,57

white-pink, painless, pedunculated, sessile, multiple exophytic nodules,

cauliflower like on lips, mucosa, soft palate or tongue

need to remove to avoid transmission

35
Q

HPV verruca vulgaris/common wart

A

caused by HPV 2,4,6,40

starts as painless papule with papillary projections/pebbly surface

pedunculated, sessile, enlarges

stays for months to years, disappears spontaneously 2/3 of the time

found on vermillion border, lip mucosa, ant tongue

36
Q

HPV verruca vulgaris transmission

A

virus enters thru break in skin, remove as it’s contagious, avoid self inoculation

37
Q

HPV condyloma acuminatum/venereal wart

A

30 types of HPV
6,11 low risk
16, 18= 95% of cervical cancer

EO: may be invisible
multiple, flat, pink, exophytic w/ sessile bases, cauliflower like

IO:
painless papular pink exophytic mass with rough appearance, often clustered. enlarge to nodules
found on: labial mucosa, soft palate, labial/lingual frenum, oropharynx

38
Q

HPV Condyloma Acuminatum/venereal wart transmission

A

HPV 16, 18, 31, 45 transmission is high
risk of malignancy

tx: excision, antiviral, vaccine before sexually active

child abuse concern

39
Q

HPV: Multifocal Epithelial Hyperplasia (Heck disease)

A

HPV 13 and 32

generalized pink translucency, cauliflower like with multiple discrete papules soft on palpation

less papular then other HPV

found on lips, tongue, B mucosa

40
Q

HPV: Multifocal Epithelial Hyperplasia transmission

A

virus enter thru break/trauma in mucosa

genetic and environmental predisposition (school, day care)

regresses or time or remove it

41
Q

HPV: Sinonasal Papillomas

A

nodules in nostrils

HPV 6, 11

HPV 16, 18 are malignancy risk

assoc with sq cell carcinoma

42
Q

periodontitis/gingivitis

A

ANUG, ANP, linear gingival erythema

tx: schedule regular perio maintenance therapy

43
Q

HIV/AIDS

A

xerostomia and enlarged salivary glands

recurrent aphthous ulcers: never vesicular at first or clustered or prodromal

ranulas (swelling, sub lingual sal glands that don’t drain)

schedule regular perio therapy

44
Q

Risk Factors for HPV

A

male, smoking, cannabis, 16 or more lifetime partners

45
Q

Role of DH

A

hx of smoking 85%
sex 69% comfortable to share

lab testing for HPV

46
Q

Vaccine for HPV

A

prevents 100% of 16 and 18 and 99% for 6 and 11

Gardasil covers all 4 types, M/W

recommended 9-26 years old

70% of Cdns infected with HPV

Dose:
15-26 years: 3 doses 2mo then 6 mon

9-14 years: 2 doses 6mo apart

47
Q

5 types of HPV

A 
squamous papilloma
verruca valgaris
condyloma acuminatum
multifocal epi hyperplasia
sinonasal papillomas
48
Q

CD4 receptors + enzymes

A

destroy T helper cells and NK cells, invade, reduce production of Ab

3 enzymes: reverse transcriptase, protease, integrase

capable of antigenic variation

49
Q

Progression of HIV

A

Health: 800-1200 T cells

Stage I: >400 cells (acute retroviral syndrome)

stage II: 200-400 cells (clinical latency)

stage III: <200 cells (AIDS)

50
Q

200-500 count

A

thrush, OHL, shingles, TB

51
Q

<200

A

HSV, Candida esophagitis, PCP, Kaposi’s, HPV

52
Q

<100

A

histoplasmosis, toxoplasmosis, cryptococcosis

53
Q

<50

A

aspergilli, mycobacterium, avium complex (MAC), Cytomegalovirus (CMV)

54
Q

Other Oral Manifestations

A

Candidiasis: pseudomembranous, erythematous, hyperplastic (smoking). yellow white curd like deposits that bleed

OHL: bilateral white plaque on tongue border, EBV

TB: painful nonhealing ulcers on mucosa

HSV: recurrent herpetic stomatitis; vesicles become ulcers, kaposi’s; purple red macules

Histoplasmosis: ulcers with indurated borders

Cryptococcosis(yeast): nonspecific ulcers

Cytomegalovirus HSV5: irregular ulcers covered with pseudomembranous, persistent

Tonsillitis

55
Q

IO manifestations significant to HIV pts

A

Aspergillosis: large necrotic ulcers with black coat

Toxoplasmosis: lymphadenopathy

Syphilis: chancre, mucus patches, gumma

Odynophagia: pain on swallow

Lymphadenopathy

GI reflex disease

Non hodgkin lymphoma: rapid painful masses often ulcerating on ging or palate

56
Q

Crimean- Congo Hemorrhagic Fever

A

tick borne virus

headache, fever, back pain, vomit

red throat, petechia on palate, red eyes, jaundice, mood changes

large areas of bruising, uncontrolled bleeding, nose bleeds

50% fatal, no vaccine yet

prevent with repellent, gloves, long sleeves

bioterrorism

oral path (3 decks)

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